CHAPTER 30: Deceased Donor Management

THE CREATION OF THE ORGAN DONATION SYSTEM

Historical Timeline of Organ Donation

• 1954 First successful living donor organ transplant –Joseph Murray MD¹

• 1963 First organ recovery from a brain dead donor¹

• 1968 Uniform Anatomical Gift Act (UAGA)

• 1969 Formation of the Southeast Organ Procurement Foundation (SEOPF)

• 1977 Implementation of the first computer-based organ matching system

• 1980 Uniform Determination of Death Act²

• 1982 SEOPF establishes the Kidney Center

• 1984 National Organ Transplant Act (NOTA) passed by Congress, establishing the Organ Procurement and Transplantation Network (OPTN), the Scientific Registry of Transplant Recipients (SRTR), providing for Organ Procurement Organizations (OPOs), and prohibiting the selling of human organs^1,3

• 1986 United Network for Organ Sharing (UNOS) is awarded the first contract for establishment and operation of the OPTN by the Department of Health and Human Services (HHS)

DONATION AND THE LAW

• NOTA is the legal framework system for organ donation and transplantation.

• NOTA facilitated organ donation by establishing a national registry and prohibited the sale of organs.⁴

THE RIGHTS OF THE DONORS

• The UAGA legally protects the rights of the individual to become an organ donor.

• The UAGA system also protects the individual’s right to become an organ donor if death is formally declared.

• UAGA defines the authorized party most responsible for acting on behalf of the deceased.³

• Regardless of family demographics or other characteristics, caregivers and OPO representatives should provide all patients with equal opportunities for organ donation.

• Clinicians and OPO representatives should be aware that a patient’s own authorization for organ donation through a donor registry is increasingly common and that this can assist in conveying the potential donor’s wishes to the family.

• The OPO must approach the authorized party or next of kin to give authorization on behalf of the deceased individual to become an organ donor, usually in the knowledge that the first-person authorization (FPA) had been expressed.

• The FPA provides helpful information for the OPO.

• Some countries in Europe have a presumed consent system, which means that organ donation is automatically considered in patients declared brain dead, unless they have specifically registered their wish not to donate.

UNDERSTANDING AND DEFINING BRAIN DEATH

• The concept of brain death was first described in 1967 by the Harvard Medical School Ad Hoc Committee.⁵

• The first legislative definition of death in the history of the United States was enacted by the state of Kansas in 1967.⁶

• Finland became the first country to adopt brain death as a legal definition in 1971.⁶

• In 1981, brain death was legally defined as the cessation of neurologic functions by the Uniform Determination of Death Act.²

• A determination of death must be made in accordance with accepted medical standards.

• The American Academy of Neurology has recently revised the guidelines for the proper ...